Search Results (184)

A 10-year-old castrated male Chihuahua weighing 3.06 kg was presented with a chronic, progressively worsening cough of five months’ duration. Diagnostic imaging, including thoracic radiography and computed tomography, identified a well-defined cranial mediastinal mass consistent with a thymic tumor. Surgical excision was performed via median sternotomy with complete thymectomy. Following tumor removal, sternal closure was achieved using a non-absorbable ultra-high-molecular-weight polyethylene (UHMWPE) suture material (FiberWire^®, Arthrex, Naples, FL, USA). Histopathological examination confirmed the diagnosis of an epithelial-predominant thymoma with narrow but complete surgical margins. Postoperative recovery was uneventful, and the dog was discharged three days after surgery. Clinical signs, including coughing, progressively improved during follow-up. Radiographic evaluation performed up to postoperative day 57 demonstrated stable sternal alignment without evidence of dehiscence, implant-related complications, or disease recurrence. This report describes the first clinical case of FiberWire use for median sternotomy closure following thymectomy in a dog. The favorable clinical and radiographic outcomes observed during postoperative follow-up suggest that FiberWire may represent a viable alternative to traditional stainless-steel wire for sternal fixation in canine thoracic surgery. Full article

Background/Objectives: Robotic thymectomy has become the preferred approach for the management of thymoma. Although robotic surgery allows for precise dissection, the contralateral pleura may accidentally be opened during thymus gland dissection, resulting in a tension pneumothorax due to the escape of CO₂ through the defect into the contralateral pleura or to significant postoperative air leaks and delayed drain removal. To prevent this potential complication, closure of the pleural defect is indicated. This procedure may be challenging using stitches or clips, especially during robotic surgery, as the pleura is a thin structure. Methods: We reported our preliminary experience in closing a pleural defect through application of a collagen pad; after applying the pad over the defect, gentle and uniform pressure was applied using a dry sponge for 2 min to seal the tissue surface. The pad closed the defect and formed a barrier that blocked the escape of CO₂ into the contralateral pleura. Results: This procedure was successfully performed in three consecutive patients to repair a defect in the contralateral pleura that occurred during RATS thymectomy for the management of B1 thymoma (n = 2) and B2 thymoma (n = 1). No intraoperative and postoperative complication was found, and six-month follow-up showed no recurrence. Conclusions: Closing pleural defects with a collagen pad is a promising technique to enhance safety during robotic thymectomy. Full article

Thymic malignancies are rare cancers arising from thymic epithelial cells and are characterized by a highly diverse clinical phenotype, substantial histologic and morphologic heterogeneity, and frequent associations with autoimmune syndromes. Although the clinical, immunological, and cytoarchitectural changes associated with thymomas have been increasingly elucidated in the contemporary literature, very few studies have interrogated the direct role of tumor staging and histological grading in shaping autoimmunity burden and infection risk. In this narrative review, we synthesize contemporary clinical, immunological, and morphologic evidence linking thymic architecture and selection defects to the spectrum of paraneoplastic autoimmunity (MG, pure red cell aplasia, Good’s syndrome) and to infectious vulnerability. We further appraise emerging therapeutic strategies, including immune checkpoint inhibition and adoptive cellular approaches, through a patient-stratified lens, emphasizing efficacy signals, immune-related adverse events, and practical considerations for selection and monitoring. We conclude by highlighting priorities for future investigation, including refining autoantibody signatures; mapping thymic microenvironments that drive tolerance failure, and prospectively evaluating stratified immunotherapeutic regimens that balance benefit with immune-mediated risk. Full article

Background: Computed tomography (CT)-guided lung biopsy plays a pivotal role in diagnosing thoracic lesions. However, its diagnostic yield may be compromised in large, necrotic, or heterogeneous tumours due to inadvertent sampling of non-viable tissue. Dual-energy CT (DECT) iodine mapping provides functional imaging by identifying iodine-avid, perfused areas, thereby offering the potential to improve biopsy targeting. Methods: This single-centre retrospective study evaluated the clinical feasibility and diagnostic performance of DECT-guided biopsy. Adult patients with suspected necrotic lung or mediastinal lesions who underwent DECT iodine mapping prior to CT-guided biopsy between April 2021 and December 2022 were evaluated. DECT iodine maps were generated using dual-source CT and used to identify viable tumour regions for targeted biopsy. The primary outcome was diagnostic yield, defined as obtaining a definitive histopathological diagnosis. Secondary outcomes included safety and adequacy of samples for molecular testing. Results: Twenty patients were included. A definitive diagnosis was obtained in 18/20 biopsies (90%). Diagnostic yield was 9/11 (81.8%) for pulmonary lesions and 9/9 (100%) for mediastinal/pleural lesions. Diagnoses included non-small-cell lung cancer (n = 8), Hodgkin lymphoma (n = 4), thymoma (n = 3), and other malignancies (n = 3). Biopsy material was sufficient for additional molecular testing in 13/20 cases (65%). Complications were minor (one pneumothorax not requiring drainage and two self-limited bleeding events). Conclusions: DECT iodine map-guided targeting was feasible in this retrospective cohort and was associated with high diagnostic yield, low complication rates, and frequent acquisition of tissue suitable for molecular analyses. Prospective controlled studies are needed to quantify benefit over conventional CT guidance. Full article

Background/Objectives: Thymomas are the most common tumors of the anterior mediastinum. While early-stage disease often has a favorable prognosis, therapeutic options in advanced stages remain limited. Moreover, the molecular profile of thymomas is still poorly characterized. In the present study, we explored the presence of targetable mutations and programmed death-ligand 1 (PD-L1) expression in a cohort of surgically resected thymomas. Furthermore, we investigated the correlation between PD-L1 expression, histological subtype, and risk of recurrence in patients who underwent curative-intent thymectomy. Methods: Mutational profiling was performed using a DNA-based NGS Cancer Panel of 16 genes. PD-L1 expression was evaluated via Tumor Proportion Score (TPS), and thymomas with TPS ≥ 50% were identified as high expressors. The associations with histological subtype and disease-free survival (DFS) were analyzed using logistic regression, Cox proportional hazards models, and Kaplan–Meier survival curves. Results: In our study, 2/37 (5.4%) of tested neoplasms (type AB and B2 thymoma) reported as a PIK3CA mutation; no other targetable mutations were observed. Moreover, high PD-L1 expression (≥50%) was reported in (15/37) 40.5% of patients and was significantly associated with aggressive histological subtypes (B2 and B3) (p < 0.001). Logistic regression analysis showed that high PD-L1 expression was a significant predictor of aggressive histology (McFadden’s R² = 0.268, p < 0.001), with an odds ratio of 15.5 (95% CI: 2.9–83.4; p = 0.001). During follow-up, 5/37 (13.5%) of patients experienced disease recurrence; however, no significant difference in DFS was found between high and low PD-L1 expression groups. Conclusions: Our data confirm the presence of PIK3CA mutations in thymomas and encourage the exploration the potential role of molecular target therapy in this setting. Moreover, we underlined that high PD-L1 expression level is associated with more aggressive thymoma subtypes and may have a role as a prognostic biomarker. These findings support the need for further studies on the potential role of molecular and predictive pathology in thymic epithelial tumors. Full article

Background/Objectives: Thymic epithelial tumors (TETs) are rare, histologically heterogeneous neoplasms lacking robust molecular biomarkers. Hippo pathway dysregulation—driving YAP/TEAD-dependent transcription—has been implicated across cancers, but transcript-level data in TETs are limited. Methods: We profiled 26 (23 TETs and three normal thymus) formalin-fixed and paraffin-embedded (FFPE) specimens by SYBR real-time quantitative polymerase chain reaction (RT-qPCR) across World Health Organization (WHO) subtypes, focusing on core Hippo components YAP1, TEAD4, MST1, SAV1, LATS1, and MOB1A. Expression was normalized to the geometric mean of HPRT1 and TBP and reported as log₂ fold change (log₂FC) using the 2^−ΔΔCq method relative to the pooled normal. Group differences were compared using non-parametric tests. Results: Median log₂FC values showed subtype-dependent upregulation of YAP1/TEAD4, notably in type A (YAP1 ≈ +3.43) and B3 (YAP1 ≈ +2.78) thymomas, with TEAD4 strongly increased in thymic carcinoma (TC; ≈ +3.49) and elevated in type A/B3. Upstream kinases tended to be subtype-specifically reduced, particularly in TC (MST1 ≈ −1.38; LATS1 ≈ −1.34), and modestly in B1. SAV1 was elevated in type A (≈+2.25) and B3 (≈+2.01), while MOB1A remained near baseline. Differential expression among WHO subtypes (Kruskal–Wallis) was significant for YAP1 (p = 0.003), TEAD4 (p = 0.015), SAV1 (p = 0.004), MST1 (p = 0.012), and LATS1 (p = 0.036), but not for MOB1A (p = 0.09). Conclusions: TETs seem to exhibit subtype-dependent expression patterns of core Hippo pathway components, characterized by enhanced YAP1–TEAD4 transcriptional output in selected subtypes and marked reduction of the MST1/LATS1 kinase module, most pronounced in TC. These exploratory patterns nominate candidate markers for subtype stratification and clinical validation. Full article

Background: Thymic epithelial tumors (TETs), including thymic carcinomas and thymomas, are rare malignancies originating in the mediastinum. Therapeutic options remain limited for patients experiencing disease progression following platinum-based chemotherapy. High tumor mutational burden (TMB) is uncommon in thymic malignancies but may predict response to immunotherapy. We report a patient with TMB-high TET who participated in the KOSMOS-II study in South Korea and achieved a durable response to atezolizumab without developing immune-related adverse events (irAEs). Case presentation: A 73-year-old woman who had been treated for thymoma 20 years ago presented with a left neck mass. A biopsy of the neck mass confirmed recurrent thymoma, type B3, and her disease progressed despite platinum-based chemotherapy and subsequent pemetrexed treatment. TMB-high thymoma is very rare, but based on the next-generation sequencing (NGS) results, she was diagnosed with TMB-high (20.3 mutations/Mb) thymoma. As TMB-based immunotherapy is not approved in Korea, she was enrolled in the KOSMOS-II study and initiated on atezolizumab following molecular tumor board review. She achieved stable disease after three cycles and has remained progression-free for 14 months, completing 20 cycles without significant irAEs. Notably, her underlying myasthenia gravis did not worsen during treatment. Conclusions: This case demonstrates a favorable outcome with biomarker-directed ICI treatment in recurrent thymoma with limited treatment options, highlighting the importance of appropriate molecular markers to predict drug response. Although TMB-based immunotherapy is FDA-approved in the U.S., it remains unavailable in Korea, underscoring the need to explore flexible access pathways, including the potential use of immunotherapy beyond current indications, to improve treatment options for patients with life-threatening conditions. Full article

Background: Autophagy, a self-destructive cellular mechanism with a paradoxical nature, plays a part in both tumor suppression and induction by providing cancer cells with metabolic substrates, resulting in cell proliferation and survival. In this study, we aim to investigate the clinical significance of four autophagy pathway components (BECLIN, p62/, LC3b, ATG3) in pathogenetic mechanisms of thymic epithelial tumors (TETs) with possible prognostic importance. Methods: Immunohistochemistry was used to evaluate the cytoplasmic expression of BECLIN, p62, LC3b, and ATG3 in tumor cells of 99 TETs, and possible correlations with clinicopathological parameters were examined. Results: Higher BECLIN and p62 expression was associated with male gender (p = 0.027 and p = 0.014, respectively). B3 thymomas and thymic carcinomas (TCs) displayed higher p62 expression (p = 0.019), while LC3b expression was marginally higher in non-B3/TC TETs (p = 0.098). A positive correlation between higher BECLIN expression and advanced Masaoka–Koga stage was also observed (p = 0.009). ATG3 was not associated with any of the investigated clinicopathological parameters (p > 0.05). There was also no significant correlation between any of the four examined molecules and overall survival or relapse. Conclusions: Our findings indicate autophagy activation in B3/TC and advanced Masaoka–Koga stage cases. Further studies are needed to explore the role of these autophagy related proteins as potential biomarkers and therapeutic targets in TETs. Full article

Objectives: Robotic-Assisted Thoracic Surgery (RATS) has emerged as a viable alternative to traditional median sternotomy for patients with anterior mediastinal tumors suspected of having thymoma or those with Myasthenia Gravis (MG). While median sternotomy remains a widely accepted standard approach, RATS has gained popularity due to its potential benefits. Methods: We retrospectively reviewed our 5 years’ experience of performing 111 surgeries for patients with anterior mediastinal tumors and patients with MG suspected of having thymoma. We performed multivariate regression models to assess the association between main demographic and clinical variables and two primary outcomes: overall complications and hospital stay. Results: Out of 111 patients, 54 were men (48.6%) and 57 were women (51.4%). The majority of surgeries (n = 93) were performed by RATS (83.8%), while the remainder were performed by either median sternotomy (n = 15, 13.5%) or by other approaches (n = 3, 2.7%). Sixty-five patients were diagnosed with thymoma (58.6%), with 96.9% R0 resection. Sixty-five patients underwent left-sided surgery (58.6%), and thirty-one underwent right-sided surgery (27.9%). The conversion rate was 2.5%. The rate of postoperative complications was 8.1 without perioperative mortality. The median hospital stay was 4.62 days, but it was significantly shorter in the RATS compared to the median sternotomy group (mean 3.64 vs. 10.67 days, p = 0.040). Conclusions: Our results suggest that RATS for patients with anterior mediastinal tumors suspected of having thymoma or for those with MG is safe and technically feasible and may be the preferred surgical approach for selected patients, whereas traditional median sternotomy remains the preferred choice for more locally advanced tumors. Full article

Sjögren’s disease (SjD), which is also known as Sjögren’s syndrome (SS), is a chronic autoimmune disease characterized by dysfunction of exocrine glands, such as the salivary and lacrimal glands, resulting in xerostomia (dry mouth) and keratoconjunctivitis sicca (dry eyes). Mice in which the SATB1 gene is conditionally deleted in hematopoietic cells (SATB1cKO mice) develop SS as early as 4 weeks of age; however, the etiology of the disease remains to be elucidated. Here, we found that the frequency of abnormally appearing CD4⁺CD8⁺ double positive (DP) T cells in the periphery of SATB1cKO mice was higher in the salivary glands than that in the spleen, suggesting a possible involvement of DP T cells in the pathogenesis of SS in SATB1cKO mice. To investigate the nature of DP T cells, we established DP T cell hybridomas by fusing T cells from the cervical lymph nodes of SATB1cKO mice with the BW5147 thymoma cell line. Among six DP hybridoma clones, the TCRβ gene from five clones exhibited a fetal or immature phenotype. In addition, four out of five clones exhibited upregulated transcription of IL-2 in the salivary glands of T/B cell-deficient RAG2^−/− mice, suggesting that autoreactive T cells were enriched in the DP T cell population of SATB1cKO mice. These results suggest that unusual DP T cells in SATB1cKO mice may be involved in autoimmune pathogenesis in SATB1cKO mice. Full article

Background: Neoadjuvant chemotherapy is generally recommended for locally advanced, potentially resectable thymic epithelial tumors. However, neoadjuvant chemoradiotherapy has been proposed as an alternative approach, potentially achieving higher complete resection rates. In this study, a retrospective analysis was conducted to compare the outcomes of neoadjuvant chemoradiotherapy (NCRT) and neoadjuvant chemotherapy (NCT). Methods: From 2009 to 2022, a total of 98 patients who underwent surgery following either NCRT (n = 30) or NCT (n = 68) for thymic epithelial tumors were included in this study. Propensity score matching was applied, resulting in two matched groups of 30 patients each. The primary endpoint was the comparison of complete (R0) resection rates between the groups. Results: In the matched cohort, the R0 resection rate was significantly higher in the NCRT group (93.3%) compared to the NCT group (73.3%; p = 0.038). The tumor regression grade was also significantly lower in the NCRT group (p = 0.002). However, no significant difference was observed in 5-year overall survival between the groups, either in patients with thymoma (100% for NCRT vs. 90.9% for NCT; p = 0.34) or thymic carcinoma (74.3% for NCRT vs. 63.2% for NCT; p = 0.82). For patients with initial local recurrence, both the 5-year overall survival and post-recurrence survival rates were 100%. Conclusions: The neoadjuvant chemoradiotherapy group demonstrated superior local control, as evidenced by improved tumor regression grades and complete resection rates. However, the absence of corresponding improvement in overall survival warrants further investigation with a larger patient cohort and a longer follow-up period. Full article

Background/Objectives: Thymoma is a rare epithelial neoplasm originating from the thymus gland, and its accurate detection and classification using computed tomography (CT) images remain diagnostically challenging due to subtle morphological similarities with other mediastinal pathologies. This study presents a deep learning (DL)-based model designed to improve diagnostic accuracy for both thymoma detection and subtype classification (benign vs. malignant). Methods: The proposed approach integrates a pre-trained VGG16 network for efficient feature extraction—capitalizing on its capacity to capture hierarchical spatial features—and an MLP-Mixer-based feature enhancement module, which effectively models both local and global feature dependencies without relying on conventional convolutional mechanisms. Additionally, customized preprocessing and post-processing methods are employed to enhance image quality and suppress redundant data. The model’s performance was evaluated on two classification tasks: distinguishing thymoma from healthy cases and discriminating between benign and malignant thymoma. Comparative analysis was conducted against state-of-the-art DL models including ResNet50, ResNet34, SEResNeXt50, InceptionResNetV2, MobileNetV2, VGG16, InceptionV3, and DenseNet121 using metrics such as F1 score, accuracy, recall, and precision. Results: The model proposed in this study obtained its best performance in thymoma vs. healthy classification, with an accuracy of 97.15% and F1 score of 80.99%. In the benign vs. malignant task, it attained an accuracy of 79.20% and an F1 score of 78.51%, outperforming all baseline methods. Conclusions: The integration of VGG16’s robust spatial feature extraction and the MLP-Mixer’s effective feature mixing demonstrates superior and balanced performance, highlighting the model’s potential for clinical decision support in thymoma diagnosis. Full article

Background: Amyloid A (AA) amyloidosis is commonly secondary to chronic inflammatory diseases or malignant neoplasms. Many types of cancers have been described as inducing AA amyloidosis, usually presenting with kidney involvement. However, there are no reported cases of concurrent thymoma and AA amyloidosis. Case Presentation: We describe a 52-year-old male presenting chest tightness. Through a series of examinations, the patient was ultimately confirmed to have AA amyloidosis secondary to thymoma, with kidney, cardiac, nerve, and soft tissue involvement. Conclusions: This case represents, to our knowledge, the first reported case of systemic AA amyloidosis occurring secondary to thymoma. It highlights thymoma as a potential underlying cause of AA amyloidosis, likely due to a chronic inflammatory response driven by the tumor. This association complicates clinical management and prognosis, requiring a heightened awareness of amyloidosis in thymoma patients who present with unexplained multi-organ dysfunction. Full article

Background: Myasthenia gravis (MG) is frequently associated with thymic abnormalities, including thymomas and hyperplasia. This study aims to analyze the clinical and pathological characteristics of thymectomized patients over a 20-year period, focusing on the relationship between thymoma subtype and MG incidence, as well as post-thymectomy remission outcomes. Methods: We retrospectively analyzed 420 patients who underwent thymectomy (open or VATS), with a mean age of 54.4 years and 59% female. Thymic pathology included thymomas (56.2%), thymic cysts (14.3%), and other lesions. 39.5% of patients had MG, of which 48.8% were thymomatous MG. Multivariate regression was used to identify predictors of MG and remission outcomes. Results: MG was significantly associated with younger age (p < 0.005), germinal hyperplasia (p < 0.001), and thymoma, especially WHO B2 subtype (p = 0.016). Six-month complete remission rates did not differ between thymomatous and non-thymomatous MG. In the subgroup undergoing VATS, median length of stay decreased to 3 days compared to 5 days in the overall cohort. The intraoperative complication rate for VATS was 1.5%, compared to 11.6% for open surgery. Conclusions: This is one of the largest single-center studies to evaluate the link between thymoma histology and MG. WHO type B2 thymoma and germinal hyperplasia were more commonly associated with MG. Comparable remission outcomes support the role of thymectomy in both thymomatous and non-thymomatous MG, emphasizing the need for individualized surgical strategies. Full article

Background: The role of thymectomy in ocular myasthenia gravis (OMG) remains controversial, particularly before secondary generalization. Methods: We conducted a multicenter retrospective study on 174 OMG patients who underwent thymectomy (112 OMG, 62 generalized OMG [g-OMG]). The primary endpoint was complete stable remission (CSR; MGFA-PIS criteria). Multivariable analyses identified predictors of CSR and generalization. Results: Mean age at surgery was 42.3 ± 13.0 years; 53.4% were male. Thymoma was present in 29.3%. CSR was achieved in 18.9% overall, significantly higher in OMG (23.2%) compared to g-OMG (11.3%, p = 0.036), with 5-year CSR probabilities of 43% vs. 22% (p = 0.017). In non-thymomatous patients, 5-year CSR remained higher in OMG (41% vs. 17%, p = 0.010). Postoperative myasthenic crisis occurred exclusively in g-OMG (8.1%, p = 0.004). Multivariable analysis identified preoperative cholinesterase inhibitor monotherapy as an independent predictor of CSR (HR = 31.776, 95% CI: 4.188–241.111, p = 0.001; non-thymomatous: HR = 19.746, 95% CI: 2.518–154.849, p = 0.005). Minimally invasive techniques (78.6%) were associated with low morbidity (5.2%). Conclusions: Thymectomy during the purely ocular stage is associated with higher CSR rates and lower perioperative neurological risk than after generalization, particularly in non-thymomatous disease. Use of cholinesterase inhibitors as sole therapy prior to thymectomy independently predicts CSR. These findings support earlier surgical consideration in selected OMG patients and highlight the safety of minimally invasive approaches. Full article